State shouldn’t rush decision on Medicaid

Friday

Feb 8, 2013 at 12:01 AM

State lawmakers should weigh unintended consequences for North Carolina’s economy and public health in moving to opt out of some provisions of Obamacare.

State lawmakers should weigh unintended consequences for North Carolina’s economy and public health in moving to opt out of some provisions of Obamacare.The Republican-controlled state Senate gave preliminary approval Monday to a bill to block the state from carrying out elements of the federal health care overhaul. The action came despite a plea from Gov. Pat McCrory’s legislative liaison for more time to consider “serious financial ramifications to North Carolina taxpayers.”The bill, co-sponsored by Sen. Tom Apodaca, R-Hendersonville, aims to block expansion of Medicaid and have the federal government, rather than the state, set up an online marketplace for health insurance. It would bar action by McCrory without legislative approval.For states that expand Medicaid to cover people up to 138 percent of the poverty level, the federal government has pledged to pay all costs for three years and 90 percent thereafter. In North Carolina, the expansion would cost the state an estimated $850 million the first six years but would bring in $16 billion in federal funds. It would also provide coverage to more than 500,000 low-income residents.GOP lawmakers worry that the federal government will back out of its commitments and leave the state saddled with a huge financial burden. This is a valid concern given the history of federal mandates upon states. Senate leaders have also questioned findings of a report that predicts expanding Medicaid would add $1.4 billion and 23,000 jobs to the state’s economy. The state is struggling to control existing Medicaid costs in the face of three years of shortfalls.State leaders should also weigh state and local costs to provide health care for more than 500,000 uninsured residents. Routine care through Medicaid is much more cost effective than treating indigent people in emergency rooms or catastrophic illness neglected due to inability to pay, says Brian Ellerby, CEO of the nonprofit Triad Adult and Pediatric Medicine, in The Business Journal.North Carolina doctors and hospitals provide $3 billion in uncompensated care to the uninsured each year, Douglas Sea and Madison Hardee, attorneys with Legal Services of Southern Piedmont, stated in an op-ed in the (Raleigh) News & Observer. These costs are passed on to insured residents, increasing annual premiums by more than $1,000 per family. Failing to address cost shifting will lead to higher premiums for all residents, suppress wages and put Tarheel State businesses at a competitive disadvantage to those in states that expand Medicaid, they wrote.In Arizona, Republican Gov. Jan Brewer opted to accept Medicaid expansion after a legal glitch was discovered, related to last year’s Supreme Court review, that would make legal immigrants but not citizens eligible for low-income insurance subsidies. In Ohio, GOP Gov. John Kasich also agreed to expand Medicaid, with the proviso that the state reverse its decision if the federal government fails to keep its pledge to pay most costs.Ohio’s action shows a state can expand coverage for low-income residents while guarding against a bait and switch by the feds. North Carolina leaders should study all the pros and cons to make an informed decision rather than rush to foreclose options.

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